Treas 5e Sneak Preview

CHAPTER 2 Clinical Judgment

NCSBN CJM LAYER 3 Table 2-2 ➤ National Council of State Boards of Nursing (NCSBN) Clinical Judgment Model (CJM) Application—cont’d KNOWLEDGE AND CONTEXT FACTORS EXPECTED BEHAVIORS/ACTIONS

NURSING ACTIONS FOR POSTOPERATIVE CLIENT 1. Analysis of vital signs 2. Assessment and analysis of intake and output 3. Maintain respiratory status a. Oxygen saturation value

b. Turn, cough, and deep breathe; incentive spirometry c. Ambulation

4. Maintain circulatory status a. Monitor intake and output b. Monitor skin color, temperature, moisture, turgor 5. Maintain skin integrity a. Positioning b. Wound care 6. Monitor laboratory results a. Hemoglobin and hematocrit b. White blood cells 7. Maintain safety a. Fall-risk assessment and appropriate follow-up measures b. Education on safety measures (use of call bell, assistance getting out of bed) 8. Pain management 9. Patient/family education 10. Discharge planning a. Postdischarge interventions b. Available resources c. Follow-up care

Knowledge Check 2-3 Identify the tasks in each layer of the NCSBN CJM.

Clinical reasoning is the process of synthesizing knowledge and information from numerous sources and incorporating experience to develop a plan of care for a particular client or case scenario. It requires a reliance on your knowledge and experience to form a conceptual image of a client’s problem and its effective manage- ment. The nurse uses this conceptual problem to guide additional data collection, then reevaluates and revises the problem until the nurse reaches a level of confidence in the diagnosis and the best approach to care (Gruppen, 2017). In essence, clinical reasoning is the application of knowledge, information from various sources, and experience to a client situation to make judgments, gen- erate alternatives, evaluate them based on evidence, and select the most appropriate action. Tools to develop and

Think Like a Nurse 2-4: Clinical Judgment in Action

■ How could factors in layer 4 have affected Jan’s performance? ■ Evaluate Jan’s strengths and areas for improvement in layer 3.

What Is Clinical Reasoning? Clinical reasoning and critical thinking are essential components of clinical judgment. Because both concepts are important to developing sound clinical judgment, we will discuss each separately.